Quelles solutions pour la garde en médecine générale? - KCE

116
Items
Affter-Hours
Primaary
Care
Drivers for systemm
reform From thhe
perspective of the GP: G
on after-hours carre
Dissatissfaction
with workload d during out of hours pperiod
in GPs
Desire for separation of work k and private life amonng
physicians
Growinng
demand for services s by the public
Non-urrgent
interventions dur ring out of hours period
Lack off
personnel and logisti ic support
The wissh
of moving costs and
workload from after-hours
to daytime
94
From thhe
perspective of the government:
g
The change
is not seen as a political but rather as a practical issue (efficciency
of care organizzation).
System reform (since
1992) Nationaal
reform of after-hours
care was implementted
January 1, 1992.
and type of reformm
Locallyy
negotiated rota syste ems were replaced by 16 county based afterr-hours
organizations with five regional baseed
services
Before as well as after the re eform there are three ttypes
of patient contaccts
Telephone
consultations
Surgeryy
consultation
Home vvisits
Number of actual models (see abbove)
used:
Type of models
Large sscale
cooperatives
Remarkk:
Each of the five reg gions in The Danish aft fter-hours system has their own telephone nnumber,
call centre andd
consultation rooms.
Financer and finanncing
GPs arre
paid using a mix of quarterly capitation (330%)
and fee-per-service
(70%).
system
Doctorss
on duty are paid a fe ee per consultation acccording
to a fee scheddule.
Fees are thus ggraded,
and doctors arre
encouraged to givee
telephone consultatioons
rather
than arrrange
for clinic consultations
or home visitss.
The dooctors
union and the regions r sign an agreeement
on the care to be provided by afterr-hours
services. The duration of that agreeement
varies, but norrmally
the
period is running for two years.
Characteristics off
model Initiatorr:
GPs (as association ns)
most frequently used
(large Numbeer
of GPs taking part in n large scale cooperattives:
scale cooperative)
Even thhough
all GP’s are ob bligated to take part inn
the after-hours care there is a voluntary coollegial
agreement thaat
the youngest GPs aare
more active than tthe
oldest
GPs. AAlthough
there is not at t lack of participating GGP’s
in the after-hourss
service and thereforee
no need to force thee
GP’s to have their shhifts.
Results
KCE Reportss
171
This coollegial
agreement is illustrated
by the numbber
of participating GP’s
in the area around AAarhus,
which is the ssecond
largest town inn
Denmark. Only arounnd
53% of
all GPss
in Aarhus take part in n the after-hours service.
Numbeer
of county based serv vices:
There aare
16 county based after-hours a organizatioons
with five regional bbased
services
Remarkk:
A national structure e for after-hours care has been defined buut
the five regions aree
allowed to establish some individual orgaanizational
solutions taaking
into
accounnt
the national structur re.
Populaation:
by region:
The Caapital
Region of Denmark:
1.7 million citizenns
Regionn
Zealand: 820.500 citi izens
The Reegion
of Southern Den nmark: 1.19 million citizzens
Centrall
Denmark Region: 1.2 25 million citizens
The Noorth
Denmark Region: 580.515 citizens
Distancce:
The lonngest
distance betwee en patient and the cooperative
is around 50 km. However the distaances
are much shorter
for most of the patieents.